Researchers at The University of Nottingham have been involved in one of the largest international studies of congenital heart disease, which has discovered gene mutations linked to three new rare congenital heart disorders (CHD).

Published in the academic journal Nature Genetics, the study also found the first clear evidence of genetic differences between two forms of the disease, and that one form can be traced back to healthy parents.

The academics in the University’s School of Life Sciences have been aiming to understand the genetic causes of heart disease, as part of an international team of collaborators led by researchers at the Wellcome Trust Sanger Institute.

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The study has sequenced and analysed the protein-coding segments of the genome – known as the exome – of 1,900 CHD patients and their parents.

Dr Anna Wilsdon, one of the Nottingham researchers involved in the project, said: “Understanding the underlying genetic pathways of congenital heart disease and the genes involved means that we will be able to provide more accurate information for patients. Knowing a genetic cause for a person’s medical condition means that we can sometimes suggest additional medical checks to keep them healthy. We can also discuss the chances of them having a child with CHD if they wish, and what options are available to them. It may also be important for the wider family, as sometimes others may be at risk of having heart problems too. For some, just having an explanation as to why they or their child has developed CHD can be very helpful.

“Through this study we have been able to identify a genetic change in a number of individuals that is likely to have caused their heart condition. We are currently feeding these results back to them. Studies like this will hopefully mean that we can find a genetic cause of CHD in more patients in the future.”

The lab in which the work was done, headed up by colleague Professor David Brook, has been studying congenital heart disease for the past 20 years.

In collaboration with paediatric cardiologist Dr Frances Bu’Lock and her colleagues at the East Midlands Congenital Heart Centre, based at Glenfield Hospital in Leicester, the team has established the collection of samples from the patients and their parents which has formed the basis for the current research, which examined a total of 20,000 genes.

CHD is one of the most common developmental defects, occurring in one per cent of the population worldwide and affecting 1.35 million newborns with CHD every year. It causes problems like holes in the heart, which in severe cases can require corrective surgery. Heart disease can cause life-long disability and is the largest cause of infant mortality in the western world after infectious disease.

Most CHD patients – around 90 per cent - have only isolated defects of the heart, and are called non-syndromic. The remaining 10 per cent of patients are described as syndromic CHD patients who have additional developmental problems such as abnormalities in other organs or an intellectual disability. It had previously been thought that both of these forms of the disease might be caused by spontaneous new mutations which are present in the child and absent in the parents.

The study confirmed that the rarer syndromic CHD patients often had spontaneous new mutations likely to interfere with normal heart development that were not seen in the parents. However, it also showed that non-syndromic CHD patients did not have such spontaneous mutations, and for the first time conclusively showed that they often inherited damaging gene variants from their seemingly healthy parents.

Parents who have a child with CHD often want to find out how likely it is that any future children will be affected. While even larger studies are needed to pinpoint the exact combination of genetic and environmental factors that contribute to heart disease, understanding these factors could one day help doctors advise parents more accurately about their chances of having a second child with the disease.

Studying these new mutation events across the genome, the researchers also found three new genes in which mutations can cause rare syndromic CHD disorders. This could help further studies identify biological mechanisms important for normal development of the embryo.

Dr Mathew Hurles, lead author from the Wellcome Trust Sanger Institute, said: “We are aiming to understand the genetics of the development of the human heart. This is the first study to quantify the role that rare inherited variants play in non-syndromic CHD, and is extremely valuable as these patients make up 90 per cent of CHD patients worldwide. We are trying to find the subset of genes with the highest risk of causing non-syndromic CHD.

“As these are rare disorders this has meant sharing data globally so we can properly investigate the genetic origins of this disease – the families that shared these data and chose to be involved in this study have helped push forward understanding of these disorders.”

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation which part-funded the research, said: “Here, research has shown for the first time that congenital heart defects are often a question of genetic inheritance. In the future, as a direct result of this research, doctors may be able to offer much clearer advice to families where one member has congenital heart disease.”

Marc-Phillip Hitz, joint first author on the paper from the Sanger Institute and Universitätsklinikum Schleswig-Holstein, Kiel in Germany, said: “Previous smaller scale studies have hinted at the possibility that non-syndromic CHD could be caused by inherited gene variants, but this is the first time that we have been able to show it with statistical evidence.

"This was only possible due to the global collaboration of centres in the UK, Germany, Belgium, Canada, the United States of America and Saudi Arabia integrating data from many clinicians on a large number of families. We now know that some of the causative factors of the disease are inherited from their healthy parents, which will be extremely helpful for designing future studies of non-syndromic CHD, helping to understand what causes the disease.”

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Notes to editors: The University of Nottingham has 43,000 students and is ‘the nearest Britain has to a truly global university, with a “distinct” approach to internationalisation, which rests on those full-scale campuses in China and Malaysia, as well as a large presence in its home city.’ (Times Good University Guide 2016). It is also one of the most popular universities in the UK among graduate employers and was named University of the Year for Graduate Employment in the 2017 The Times and The Sunday Times Good University Guide. It is ranked in the world’s top 75 by the QS World University Rankings 2015/16, and 8th in the UK for research power according to the Research Excellence Framework 2014. It has been voted the world’s greenest campus for four years running, according to Greenmetrics Ranking of World Universities.